NB Col orado Celluln, Inc. Mike Fellciuimo

<010> Study Area Code 31eou
<015>
<020> Study Area Name NB Col orado Celluln , Inc.
<030>
<035> Program Year 2015
<039>
<140> Contact Name - Person USAC should contact regarding this data Mike Fellciuimo

<141> Contact Telephone Number - Number of person identified in data line <030> 9705423605 ext·

.. ...Cont.act Email Address- Email Address of person identified in data line <030> mlke. felicioai-.rlaero.com
Coverage and Performance Report Year 01/2ou - 06/2015

q1> .;n ~ •·'f ' "'~. .~JS~ <ell:bl y~ ;z ;.,·:f ·· cM> ·: : : -: ~ -o;• _ ~ 1f:!'T;, --; ~h. ~,· · ., -A t ~· I '.I ~.

State Countv C.sus Block Resident Resident Total Resident ~dM lles RoadMU.S Totll Road c.rtifyth.t
Population per Population Populatlon per Census M. . . Coverage and
NB Dundy -died by plfCensus lllock Newly cowled per
Cenws lllodt Newly"-athtd Block !ladled Census Block P~rformacne
bys.MGe Servtca
0.07 0 . 07 0.07 data isuploodtd
310579623002443 00 0.15 0.15 0.15 (yes/DO)
0 0.14 0.14 0. 14 Yee
0.07 0 .07 0.07
u unoy 3 10 579623002••• 00 0.07 0.07 0.07 Yea
NB 0 0.07 0.07 0.07 Yes
0.11 0.11 Ye e
~...y 310579623002445 66 0.11 0.11 0.11
6 00 0.1 0.1 0.11 Yes
NE 11 11 0 .1 0.1 0.1 Yee
310579623002446 0 .l
OU.'lay 0 0.1 0.1 Yeo
0 .07 0.0'1 0. l Yes
__NB --·-z 3 10579623002447 0.07 0.07 0.07
11 0 .07 0.07 0.07 Yes
NB , 0 .07 0.07 0.07 Yes
310579623002448 0.01 0.01 0.01 Yes
Ill!: 0 00 0.1 0.1 0.07
0.13 0.13 0.1 Yea
--·-r 3105796230024 4 9 1l 0.1 0.1 0.13 Yes
l 0 .1 0.1 0.1 Yes
NE 0.1
31057'623002450 33 Yes
--Y 3 Yes
NE 88 Yes
310579623002451 22 Yes
Dunay 8 Yes

NE 310579623002 4 52 Yes
2
___,
3105796230024 53 l1
NB 1

Dunay 310579623002454 00
NB 0
5s
DundY 31 0579623002455
NE 5 00
55
Dunay 3105796230024 56 33
0
NB 4•
310579 623002457
°"'1dY 5 00
NE 00
310579623002458
uw •uY 3
NB
310579 6230024 59
NB """"'' 4

uw•uY 310579623002460
11£ 0

UU!IQY ll05796.c~vv.c 4 6l

NB ___, 0

NII 31057 9623002462 22
2
u w •u Y
NE

Percentage of D Percent.age of Total D
Total Population Road Miles covered

Reached by by Service
Service

05/29/2015

<010> Study Area Code 378014
<015>
<020> Study Area Name llE: Colorado Cellular, Inc.
<030>
<035> Program Year 2015
<039>
<140> Contact Name - Person USAC should contact regarding this data Mike Pe liciHimo

<141> Contact Telephone Number · Number of person identified in data line <030> 9705423605 ext.

Contact Email Address - Email Address of person identified in data line <030> 9'ike. felici••imoeviaero. coai
- . ........ . ---~Of>-· .. CIZ>..:-·· ::- ":~·' -~~.·
Coverage and Performance Report Year 07/2014 • 06/2015

..,.•.!IO.U'', W" l ..~17 ca> ,. __ ., « . ~ ····-~-v~· ..;;:·::11'-i'.. : ~ ...r.::r;:·\

Resident Resident Tobi Resident RoadMUts Road Mies Total Road Certify that
Population Population per Census per Census Mies Coverace and
Populatlon per Newly Reached Reached by Block Newly COVMedper Performacne
Block Reached Censu.s Block data ls uploded
si.te Countv Census Block Census Block bySenico Service 0 .OB
Dundy 0.05 o.oe o.oe (yes/no)
NE 310579623002'63 11 0.11 Yes
Nil v-•~7 1 0.07 0.05 0 . 05
NE 0.07 O.ll 0.11 Yes
NE uum•Y 310579623002464 22 0 . 07 0.07 0.07 Yee
2 0.07 0.07 0.07
uuuuy 0.06 0.07 0.07 Yea
3105796230024 65 22 0 .02 0.07
NE ____, 2 0.07 0.06 0.07 YU
55 0.02 0.06 Yea
NE ____, 3105796230024 70 33 0.07 0.07 0.02
5 0.1 4 0 .07 Yea
NE 00 0.01 0.07 Yes
3105796230024 71 l.59 0.14 0. 07
---Y 3 •• 0.13 0.01 0 .14 Yes
0.01 1.59 0. 01 Yes
NE 310579623002472 00 0.17 0.13 l.59 Ye s
0 0.07 0.01 0 . 13
l.lUn<ly •• 0.1 0.11 0.01 Ye e
•3105796230024 73 0.1 0.07 0.17 Yea
NE ____, 22 0.1 0.07 Yea
310579623002474 0.1 0.1
NE 0 0. 1 Yes
Yea
1.>Unay •310579623002475
llE Yea
310579623002480 Yea
l.lUnay 2 Yes
llE
3105796230024 81 44 Yea
1.>Unay 4
NE 11
310579623002482
Dunay 1 00
NE
310579623002483 00
--·-Y 0 00

NE 310579623002485 00
0
.......~y ••
llll 310579623002486
0 00
--·-Y 55
310579623002487
llll 0 1l
..........y
3105796230024 8'
NE
•
--·-r
310579623002489
NE 0

uu."lay 31vo 9623002491
Ill!! 5

310579623002492
1

Percentage of D Percentage of Total D
Total Population Road Miles covered

Reached by by Service
Service

0 5/ 29/2015

<010> Study Area Code 378014
<015>
<020> Study Area Name NE Colorado Cellular, Inc .
<030>
<035> Program Year 2015
<039>
<140> Contact Name - Person USAC should contact regarding this data Mike Felicissimo

<141> Contact Telephone Number - Number of person identified in data line <030> 9705423605 ""~-

Contact Email Address - Email Address of person identified i n data line <030> mike.!eliciasilD08Viaero. com
__Coverage and Performance Report Year
. ,. 07/2014 - 06/2015

bM. . ;,--:- ~ i:I.' ' 4'l> · ;;-;- , ~ .··. .•· I 61>..'.'' .Cl> .~ -~ ~~~ ,...~ ,Jft . M< ...._. •'!f L~

State CcunlY ClftSUS 8lodl Resident Resident Total Resident Road Miles Road Miies Total Road Certify th1t
NB Dundy 31057962300208 Populatloll .... Population Populatlon per Census perc- Miies Covllfll••nd
NE c.nsus 8lodc Newly Reac.hed Reached by Bloclt Newly c-edptlf Pe<formacne
Nl! --'--Y Blad< RHched Clftsusllod< data Is uplo.ded
NE 0 by Service Service 5.35
uunoy S.35 5.35 (yes/no)
00 1.32
D\l.'lOy 1.32 1. 32 Yeo
31057962300209 00 0.15
0 0.1~ 0.15 Yeo
0.13
310579623002500 00 0.13 0.13 Yeo
0
•• Yeo
310579623002501
4

Percentage of D Percentage of Total D
Total Populati on Road Miles covered

Reached by by Service
Service

05/29/2015

.--------- ·--------------------.

Mobility Fund FCC Fon,
Approved by OM 9
Phlse 1 •§54.1009 An~ual Repe>rtlng
OMS 3060-llE 5
Data Collection Fonn Avg. Burden Estimate per Respondent: 18 Hou1 s

<010> Study Area Code 378015

<OlS> Study Area Name NE Co lor ado Cel lular , Inc. JUL - 12015
<020> Program Year 2015

<030> Contact Name: Person USAC should contact i<:i ke Pelic:ieah:o federal Comm~~
Offtse ef tfle Seet!tay
_ _ _ _wi_t_h-'q_ue._st_io_n_s_a_bo_u_t-'t_hl.;..s.;..da'""'t.;..a________________________

<035> Contact Telephone Number: 9705426 305 ut.

Number ot the person identitled in data line <030>

<039> Contact Email: mi k e. f e lic:iuiinoeviaero. c om
Email ot the person identitied in data line <030>

Q<040> Has the infonnation required pursuant to §54.1009 been provided with a Fonn 481 filing (Y/Nl <040> @

<041> Attach a description of the documents filed with the Form 481 reporting 4M~I

<042> Cite the Study Area Code (SAC) for the Form 481 reporting <042>

<050> Carrier Contact lnfonnatlon <050> [ { ]

<060> Coverage and Performance Report <060> [ { ]
<070> [ { ]
<070> Urban Rate Comparability Certification
0®
<080> Tribal Lands Reporting !yin?l (Don this study a~ c:over tribal lands? Yn orNo)
<080> 0
(If yn, complttl th• ottodwd worlcshttt) <090>[{]

<090> Pro!ect Update Information (c:omplftt attach«! workshHt) <101> [ { ]

<100> Certifications (comp/ot• attach«! artlfk#tlon) D<102>
<101> Reporting Carrier Certification (c:omplrt• ottodwdurtifict1tioll)

<102> Agent Certification

Notice to Individuals Required by the Paperwork Reduction Act of 1995
OMB Control Number 3060-1185 (Annual Report for Mobility Fund Phase I Support, FCC Form 690 and Record Retention Requ irements)
Notice to Individuals Required by the Paperwork Reduction Act of 1995
Public reporting burden for this collection of information is estimated to average 18 hours per response. Our estimate includes the time to read
the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. ff you
have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal
Communications Commission, Office of Managing Director, AMO· PERM, Washington, DC 20554, Paperwork Reduction Act Project (3060·1185).
Please DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. You are not required to respond to a collection of information sponsored by the
Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number
and/or we fail to provide you with this notice. This collection has been assigned an OMS control number of 3060·1185.

THIS NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.

05/29/2015

Page 1

<010> Study Area Code 378015
<OlS> Study Area Name .NB Colorado Cel lular. I nc.
<020> Program Year 2015
<030> Contact Name - Person USAC should contact regarding this data Mike Pelicie•imo
<035> Contact Telephone Number - Number of person identified in data line <030> 9705426305 ex<.
<039> Contact Email Address - Email Address of person identified in data line <030> mUcs; teli cioei mtyioero £911

Reoortinc C!rrier I Mobility Fund Phase 1 Winning Bidder 000831050
<110> FCC Registration Number NB Color&do Cellular Inc.
<111> Filing Carrier Name NE Colorado Cellu lar. Ins .
<112> Winning Bidder Carrier Name 1224 W Pl•tte Avenue
<113> Street Address (or PO Box) Fort Morga n
<114> City
<115> State co
<116> Zip-Code
<117> Telephone Number 80701
<118> Fax Number 9705 4 23605 ext.
<119> Email Address 9708673589
i=ike. telieiss imoeviaero.ccm

Contact Information f'.ikr felisip1im
if same as above, indicate in this box N~ Colorado Oel l ula.r, Inc.

<120> Name (First, M l, last, Suffix) Port Morgan
<121> Filing Carrier Name
<122> Street Address (or PO Box) co
<123> City
<124> State 80701
<12S> Zip-Code 9705423605 ext.
<126> Telephone Number 9708673589
<127> Fax Number
<128> Email Address llike. eel icissilDCleviaero.c:~

Al!lh2tlz111! ~nl lnform1tlon 0
if no agent, indicate in this box

<130> Name (First, Ml, last, Suffix)
<131> Company
<132> Street Address (or PO Box)
<133> City
<134> State
<135> Zip-Code
<136> Telephone Number
<137> Fax Number
<138> Email Address

05/29/2015

Page2

<010> Study Area Code 378015
<015>
<020> Study Area Name NE Colorado cel lular . Inc .
<030> Pro ram Year 2015
<035> Contact Name · Person USACshould contact regarding this data Mike l>e l i cissimo
<039> Contact Telephone Number · Number of person identified in data line <030> 970 542630 5 ext.

Contact Email Address - Email Address of person identified in data line <030> mike . f e l i cissi moaviaero.com

<140> Coverage and Performance Report Year 07/ 2014 • 06/2015

Front ier county SAC378015 Broadband Shape region . z i p ,

Pront ier=Count y:sAC378015:Voice_ shaPe_regi on. z ip ,

Front ier_County_NE_31063 961100124 l_Submission_po i nt. zip

Coverage and Performace attachements

<141> ~,)!'"' ,_ v ~- ···~ ~''~!.~' ~·...K !<bi>'. .:.~·'H ,~;ih~,~~ .;;_;- -::-":;)~.'°' .r ...._,.,.~_ ,;•·CU

Total

Road Road Certify that
Coverage and
Road Miles per Miies Performance data

Resident Total Resident Miles Census covered Is uploaded

Resident Population Population per Block per (Yes/no)

Population per Newly Reached Reached by Census Newly Census

State County Census Block Census Block by Service Service Block Reached Block

-- ' :oo ~tt~rl- br1 \A1nr~ - ~l

--

DPercentage of Total DPercent age of Total

Population Reached by Road Miles covered
Service by Service

05/ 29/20 15

Page3

<010> Study Alea Code 378015
<015> Study Alea Name ~'1 Colori>do Cellul ar, l nc.
<020> Pr ram Year 2015
<030> Mike Felici aeimo
<035> Contact Name • Person USAC should contact regarding this data 9705426305 ext .
<039> Contact Telephone Number· Number of person Identified in data line <030> mike. fel ici a•imo9viaero. com
Contact Email Address . Email Address of person identified in data line <030>

TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING CERTIFICATION DATA ON ITS OWN BEHALF:

Certification of Officer or Employee as to compliance with 47 CFR §54.1009(a)(4)

I certify that I am an officer or employee of the reporting carrier; my responsibilities Include ensuring compliance with 47 OR §54.1009(1)(4), the information reported on this

form and In any attachments Is accurate.

Name of Reoorting Carner: NE Colorado Cellular, Inc.

Si«nat ure of Authorized Officer. Cl!RTIPIBO ONLINE Dat e 06/ 30/201 5

Printed name of Authorized Officer: Mi ke f'elicioeilllO

Tit.le or oositlon of Authorized Officer: Exe cutive Vi ce President

Telephone number of Authorized Officer: 97054 23605 ext.

.Study Area Code of Reoortlna Carrier: 378015 Fllina Due Date for this fonm: 07/01/2015

P~ wil~ully ,,,.king false statements on this form can be puni.ned by fine or forfeiture under the Communications Act of 1934, 47 U.5.C. §§ 502, 503(b), or fine or imprisonment
under Title 18 of the Un11ed States Code, 18 U.S.C. § 1001.

TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING CERTIFICATION DATA ON THE CARRIER'S BEHALF:

Certification of Officer or Employee to authorize an Agent to file compliance with 47 CFR §54.1009(a)(4) on Behalf of Reporting Carrier

I certify that (N•m• ofAgent) Is authorized to submit the Information reported on behalf of the repor1lng

curier. I also cer1lfy th1t I •man officer or employee of the repor1lng carrier; my responsibilities include ensuring compliance with 47 CFR §54.1009(a)(4) reported to the

authorized •11•nt· and, to the beat of my knowledae. the TWPOrU and data provided to the •uthorized •oent la accurate.

Name of Authorized A.Rent:

Nam e of Reporting Carrier:

Signature of Authorized Officer or Emplovee: Date:

Printed name of Authorized Officer or EmPlovee:

Title or position of Authorized Officer or Employee:

Teleohone number of Authorized Officer or Emolovee:

Study Area Code of Reporting Carrier: Filing Due Date for this form:

Penons willfully making f1lse statements on this form can be punished by fine or forl.iwre under the Communlcltlons Act of 1934, 47 U.S.C. §§ 502. 503(bl, or fine or imprlsonrMnt
under Title 18 of the United States Code, 18 U.S.C. § 1001.

TO BE COMPLETED BY THE AUTHORIZED AGENT:

Certification of Agent Authorized to File compliance with 47 CFR §54.1009(a)(4) on Behalf of Reportln1 Carrier

1, as agent for the reportinc carrier, certify tNt I am authorized to submlt the certlflcation on behalf of the report1111 carrier; I have prollicled the data reported Mrein based on

best«data provided by the reportinc carrier; and, to the my knowledge, the Information reported herein Is accurate.

Name of Reporting Carrier: Date:
Name of Authoriied Aaent or Emolovee of A.Rent:
Signature of Authorized Agent or Emplovee of Agent: Filing Due Date for this form:
Printed name of Authori zed Aaent or Emolovee of Altent:
Title or position of Authorized Agent or Employee of Agent
Teleohone number of Authorized AJ!ent or Emplovee of AJ!ent:
Study Area Code of Reoorting Carrier.

Persons willfully makl~ falH statements on this form can be punished by fl'le or forl.iture under the Communlcltlons Act of 1934, 47 u .s.c. §§ 502. 503(b), or fine or imprbonment under
T1tle 18 of the Un11ed States Code, 18 U.S.C. § 1001.

Page4

05/ 29/ 2015

<010> Study Area Code 11ao1s
<015> Study Area Name NB Colorado Cellul ar, .Lnc.
<020> Program Year 2015
<030> Contact Name - Person USAC should contact regarding this data ltik e Pelic i n ia'.o
<035> Contact Telephone Number - Number of person identified in data line <030> 21os4261os exc.
<039> Contact Email Address - Email Address of person identified in data line <030> mike.felici 881mo1yias:ro.com

<142> State

<143> County

<144> Tribal Land(s) on which ETC Serves

<145> Tribal Government Engagement Obligation

Nomt ofAttached Documtnt{.pdfl

If your company serves Tribal lands, please select (Yes, No, Not Applicable) for
each of these boxes to confirm the status described on the attached
PDF, on line 145, demonstrates coordination with the Tribal
government pursuant to§ S4.1004 includes:

Select
(Yes, No, Not Applicable)

<146> Needs assessment and deployment planning with a focus on Tribal
community anchor institutions;

<147> Feasibility and sustainability planning;
<148> Marketing services in a culturally sensitive manner;
<149> Compliance with Rights of way processes

<150> Compliance with Land Use permitting requirements

<151> Compliance with Facilities Siting rules

<152> Compliance with Environmental Review processes
<153> Compliance with Cultural Preservation review processes

<154> Compliance with Tribal Business and Licensing requirements.

Page S

05/29/2015

<010> Study Area Code 378015
<015> Study Area Name NE Colorado Cel lular, I nc.
<020> Program Year 2015
<030>
<035> Contact Name - Person USAC should contact regarding this data Mike Fel icissi mo
<039>
Contact Telephone Number - Number of person identified in data line <030> 9105426305 e.xt.

Contact Email Address- Email Address of person identified in data line <030> mike .te11c1ss1.-v1aero.com

<200> Date Authorized to Receive Support 107/29/2013
<201> Targeted Completion Date lo1/31 /2016
<202> Total Mobility Fund Support Awarded 185674 . 05
<203> Total Mobility Fund Support Disbursed l2ssss . 02

<210> Actual Completion Date I04/ 22/2015
<211> Project Status Description (attached)
Nebraska S ites complete.pdf

<212> Please check these boxes below to confirm that the attached PDF, on line Nome a PDF ottoc e
<213> 211, contains a project status pursuant to §54.1005(b)(2)(v). The information
<214> shall be submitted as appropriate. I
<215> Status of Network Deployment - Network Design I
<216> Status of Network Deployment - Construction I
<217> Status of Network Deployment - Deployment
Status of Network Deployment - Maintenance I
Project Budget Status
Project Plan Status

<218> Certify Network will Support 3G/4G Mobile Service (Yes I No) ®0

Page6

05/29/2015

<010> Study Area Code 37801 5
<015> Study Area Name ti;E Colo r a do Ce llul arl Ine.
<020> Program Year
<030> Contact Name - Person USAC should contact regarding this data 20 15
<03S> Contact Telephone Number- Number of person identified in data line <030>
<039> Contact Email Address - Email Address of person identified in data line <030> Mike Fel iciea i mo

97054 26305 e xt .
mike. fel ici••ilnOltViae.ro. c om

TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING ON ITS OWN BEHALF:

Certification of Officer as to the Accuracy of the Data Reported for Mobility Fund Recipients

I certify that I am an officer of the reporting carrier; my responsibilities Include ensuring the accuracy of the reportl11g requlreme11ts for Mobility fund recipients; and, to the
best of my knowledge, the Information reported 011 this form and In any attachments Is accurate.

Name of Reporting carrier: NE COlorado Cellular, Inc.

lsianature of Authorized Officer: CERTif'li:O ONLINE Date 0 6 /30/2015

Printed name of Authorized Officer: Mi ke f'eliciuimo

h"ltle or position of Authorized Officer: Executiv e Vice Pre sident

h"eleohone number of Authorized Officer: 9705423605 ext.

Study Area Code of Reporting carrier: 378015 f iling Due Date for this form: 07/01/2015

Persons willfully maklne false statements on this form can be punished by fme or forfeiture under the Communi<lltions Act of 1934, 47 U.S.C. §§ 502, S03(b), or fine or Imprisonment
under Title 18 of the United States Code, 18 U.S.C. § 1001.

05/29/20 1& Page 7

<010> Stud Area Code 3 78015
<015> Study Area Name NE Colorado Cel lul ar, I nc .
<020> Pr ramYear
<030> Contact Name - Person USAC should contact regarding this data 2 01 5
<035> Contact Telephone Number · Number of person identified in data line <030> Mi ke Fel i cisaimo
<039> Contact Email Address - Email Address of person identified in data line <030> 970 5 4 2630 5 ext. .
mi ke . fel i ci s sime>eviaer o .com.

TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING ON THE CARRIER'S BEHALF:

Certlflcatlon of Officer to Authorize an Agent to File for Mobility Fund Recipients on Behalf of Reporting Carrier

I certify that (Name of Agent\ is authorized to submit the infonnatlon reported on behalf ofthe reporting carrier. I

also certify that I am an officer ofthe reporting carrier; my responsibilities Include ensuring the accurecy of the data reporting requirements provided lo the authorized

agent; and, to the best ofmy knowledge, the reports and data provided to the authorized agent is accurate.

Name of Authorized Agent:

Name of Reporting Carrier:

Signature of Authorized Officer: Date:

Printed name of Authorized Officer:

Title or position of Authorized Officer:

Telephone number of Authorized Officer:

Studv Area Code of Reoortinit Carrier: Fillnit Due Date for this form:

Persons willfully making false statements on this form can be punished by fine or forfeiture under the Communications Act of 1934, 47 U.S.C. §§ 502, 503(b), or fine or imprisonment
under Title 18 of the united States Code, 18 u.S.C. § 1001.

TO BE COMPLETED BY THE AUTHORIZED AGENT:

Certification of Agent Authorized to File for Mobility Fund Recipients on Behalf of Reporting Carrier

I, a.s agent for the reportl,. carrier, certify that I am authorized to submit the reports for Mobility Fund recipients on behalf of the reporting carrier; I have provided the data
reported herein based on data provided by the reporti11g carrier; and, to the best of my knowledge, the Information reported herein Is aca1rate.

Name of Reporting Carrier:

Name of Authorized Agent or Employee of Agent:

Slitnature of Authorized Altent or Employee of Agent: Date:

Printed name of Authorized Agent or Employee of Aitent:

Title or position of Authorized Agent or Employee of Agent

Telephone number of Authorized A11ent or Emolovee of Aitent:

Study Area Code of Reportinit Carrier: Filinit Due Date for this form:

Persons willfully making fa~ statements on this form can be punished by flne or forfeiture under the Communications Act of 1934, 47 u .S.C. §§ 502, 503(b), or fine or imprisonment under Title

I I18of the united States Code, 18 u.s.c. § 1001.

Pages

0 5/ 29/2015

Attachments

''

<010> Study Area Code 37801 5
<015> Study Area Name
<020> Program Year NE COlorado Cellular, Inc.
<030> Contact Name - Person USAC should contact regarding this data 2015
<035> Contact Telephone Number - Number of person identified in data line <030> Hike Fel ic:issimo
<039> Contact Email Address - Email Address of person identified in data line <030> 9705• 26305 ex10.
<140> Coverage and Performance Report Year mike. teliciasimosviaero.com

07/2014 - 06/2015

·::r ..ca&i ,.,. ~ ..
<141> -·~- ..~~ -· ~~-- ~ J.; I ~ 4'ib !i..~· ':C'c,o.. ,~,~ \~'. ...-...&<.;· ; :·~ ;;t' - ~'.ti .:;::c r.~ ~•:..1.-1 ,j

Stitt County Census llodl ~esldent Resident TOhl Resident Road Miies Road Miies TOhlRoad Certify thll
NII Frontier 310639611001225 Populltlotl Populltlotl per Census per Census Mies Cover1g11nd
NB rroni:.::a.er Population per Newly Reached Re1ched by llockNewly covered per Performacne
NB Frontier ClftSUSllodl Blodl RMched Census llock d1t1 Is uploaded
NE Yront1er bySetvlce Servi<• 6.68
6 1.64 5.77 5.77 (yes/no)
NE .. - 66 0.03 1.6' 1.64 Yea
NE 1.85 0.0) 0.03
NE ··--~· 310639611001241 88 3.69 1.85 1.85 Yea
NB _ _ _c~vnt: 8 0.06 3 .69 3.69 Yea
NII 1.18 0.06 0.06
t'rontier 310639611001270 00 1.43 1 .18 Yee
NE 0 33 0.46 1.43 l. 78
P'rODt.l.e.r 00 0.36 0.46 1.43 Yes
NE 310639611001271 00 0.23 0.36 0.46
NE .--··---- 3 00 0 .02 0 . 36 Yea
NE 2.2 0 .23 0.23
Yrontier 310639611001362 0.16 0.02 0.02 Yu
NB Frontier 0 0.98 2. 06 2.06
NE P ' ro n t ie r 0.03 0.16 0.16 Yea
NE Frontier 310639611001378 0.24 0.98 0.98
NB trontier 0 0 .5 0.03 0.03 Yea
Yronti.er 0 .44 0.24 0.24
II~ 310639611001398 55 0 .5 YU
Yron~l.er 0 00 0.28 o.s 0. 44
Iii! 00 0.28 Yee
NE rrontier 310639611001406 0.44
0 .28 Yea
--··---- s Yee
YH
t-'rontier 310639611001462
0 Yee
Yee
310639611001463
0 YU
Yea
310639611001465 00 Yeo
0 Yea
00
310639611001466 00
0 00
00
310639611001469 00
0 00
00
310639611001471 00
0

310639611001479
0

310639611001410
0

310639611001417
0

310639611001488
0

310•l>ollu014"'
0

310639611001490 00
0

Percentage of D Percentage of Total D
Total Population Road Miles covered

Reached by by5ervice
Service

05/29/2015

<010> Study Area Code 378015
<015>
<020> Study Area Name NE Colorado Cellular, I nc.
<030>
<035> Program Vear 2015
<039>
<140> Contact Name - Person USAC should contact regarding this data Mike f'el icieeimo

<141> - ...... . ..Contact Telephone Number - Number of person identified in data line <030> 9705426305 &Xt.
Contact Email Address - Email Address of person identified in data line <030> mike. fel icieeimc:ll9via ero.com

Coverage and Performance Report Vear 07/2014 - 06/2015

~ ~.{: ~ -· 4llo> .. ? ,., ' J..• iiihR..(· o.t• "v d :t' .::~ ~ 1.-_...._. __... ;r .':~ _- -;;;.- r' . _ C -4 .-:

Ruldtflt Resident Taul Resldtr1t - d Miies Road Miies Total Road Certlfyt!IH
Population Population per Census per Census Miies COVtflJtHd
Population per _,., Reoched Reached by Block Newly covered per Perlorm1cne
Block Reach«! Census Blod< data Is uploaded
State County Censu>Blod< Clftsus Block bySe<va 5eM<e 0.04
Frontier 0 .21 0.04 o.o• (yet/no)
NB 310639611001525 00 0.11 0 . 21 Yee
NE r £.vnt.1er 0 0.56 0 .21
NE 2.46 O.ll 0.11 Yee
NE Pronc1er 310639611001526 00 0.05 0.56 0 .56 Yea
NE Pront.1er 0 0.69 2.4 6 2.46 Yea
NE 0.25 0 . 05 0.05
NE ~--·---·· 310639611002397 00 0.82 0.69 Yee
0 0.31 0 .25 0.69 Yee
NE . ·-··--.,... 00 0.23 0.25
NE 310639611002406 00 0.05 0.03 0.23 Yee
--··--e• 0 0.25 0.03 Yee
Ill! 0 . 21 0 . 05
NE rron~.1.er 3 106396110024 12 0.11 0.12 0.05 Yea
NE 0 0.03 0.21 0.12 Yee
NE ,.·ront1er 0.16 0 .0 0 .21 Yee
NE 310639611002414 00 0.28 0.03 0.0
NE --··---- 0 0.27 0.06 0.03 Yee
NE 1.2 0 .05 0.06 Yee
Pront1er 310639611002421 00 0.67 0.12 YU
KE Prontitr 0 0.66 o.os
F"ront1er 0 . 67 Yea
NE Frontier 310639611002457 00 0.12 Yea
NE c r o n... 1 e r 0 0.66 Yee
NE Frontier 00 0.67 Yee
a-·ront1er 31063961100248 9 00 Yee
t·ronc.1er 0
Yee
--··· ~--- 310639611002491
0
rron..;1.er
310639611002493 00
0

310639611002494 00
0 00

310639611002496 00
0 00

310639611002538 00
0 00

310639611002639 00
0 00

31063961100264 1
0

310639611002642
0

310639611002644
0

310639611002655
0

3 10639611002692 00
0

Percentage of D Percentage of Total D
Total Population R.oad Miles covered

Reached by by Service
Service

05/29/2015

FCCFo

Mobility Fund Approved by OM

P"'5e 1 • §54.1009 Annual Reporting ~ OMB 3060-11
1~' ·Hou
Data Collectk>it Form Avg. Burden Estimate per'Respondent:

<010> Study Area Code 378017
NB Col orado Cellular, inc.
<015> Study Area Name 2015
Hi ke Pel ici e •i1n0
<020> Program Year
Office Of ttie secrebit
<030> Contact Name: Person USAC should contact
with questions about this data

<035> Contact Telephone Number: 9705423605 ext.

Number ot the person ldentitted in data line <030>

<039> Contact Email: mike. fe l i cissimoeviaero.com
Email ot the person identlt ied in data line <030>

Q<04-0> Has the lnfounation required pursuant to §54.1009 been provided with a Form 481 filing IY/N) <040> @

<041> Attach a description of the documents filed with the Form 481 reporting ~bl

<042> Cite the Study Area Code (SAC) for the Form 481 reporting <042>

<050> Carrier Contact Informati on (complttt attochod worlrshHt) <050> 0

<060> Coverage and Performance Report <060> 0

<070> Urban Rate Comparabllltv Certification (compi.tr ottochtd artificotion) <070> 0

<080> Tribal Land s Reporting !yin?) (DonthiutudyarmcovtrtribollandslYesorNo) 0 @

<090> Pro!ect Update Information (compltt• ottadlod worlrshHt) <080> 0
(complttt attodltd art/fkatlon)
<100> Certifications <090> 0
<101> Reporting carrier Certification
<102> Agent Certification <101> 0
<102> 0

Notice to Individuals Required by the Paperwork Reduction Act of 1995
OMB Control Number 3060-1185 (Annual Report for Mobility Fund Pha se I Support, FCC Form 690 and Record Retention Requirements)

Notice to individuals Required by the Paperwork Reduction Act of 199S

Public reporting burden for this collection of information is estimated to average 18 hours per response. Our estimate includes the time to read
the instructions, look through existing records, gather and maintain required data, and actually complete and review the form or response. if you
have any comments on this estimate, or on how we can improve the collection and reduce the burden It causes you, please write the Federal

Communications Commission, Office of Managing Director, AMD·PERM, Wash ington, DC 20554, Paperwork Reduction Act Project (3060·1185).

Please DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. You are not required to respond to a collection of information sponsored by the
Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number
and/or we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060·1185.

THIS NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.

06/29/201S

Page 1

<010> Study Area Code 378017
<015> Study Area Name NB Colorado Cellular, Inc.
<020> Program Year 2015
<030> Contact Name - Person USAC should contact regarding this data Mike Pelicissimo
<035> Contact Telephone Number - Number of person identified in data line <030> 9705423605 ext.
<039> Contact Email Address - Email Address of person identified in data line <030> mike fel i cisaimotyiaerg com

Reporting Carrier I Mobility Fund Phase 1 Winning Bidder 0008314569
<110> FCC Registration Number NE Colorado Cellular, Inc.
<111> Filing Carrier Name NE Colo.-ado Cellular Ins
<112> Winning Bidder Carrier Name
<113> Street Addre.ss (or PO Box) 1224 w Platte Avenue
<114> City
<115> State Fort: Morgan
<116> Zip-Code
<117> Telephone Number co
<118> Fax Number
<119> Email Address 80701
9705423605 ext.
9708673589
mike. felicissim~iaero.com

Contact Information NE Col orado Cellular, I nc.
if same as above, indicate in this box
Fort Morgan
<120> Name (First, Ml, Last, Suffix)
<121> Filing Carrier Name co
<122> Street Address (or PO Box)
<123> City 80701
<124> State
<125> Zip-Code 9705423605 ext .
<126> Telephone Number 9708673589
<127> Fax Number mike. felici ssimoaviaero.com
<128> Email Address

A!.!1!l!!rized Aftn1 Information 0
if no agent, indicate in this box

<130> Name (First, Ml, Last, Suffix)
<131> Company
<132> Street Address (or PO Box)
<133> City
<134> State
<135> Zip-Code
<136> Telephone Number
<137> Fax Number
<138> Email Address

06/29/2015

Page2

<010> Study Area Code 318011
<015>
<020> Study Area Name NB Col orado Cellula r, Inc .
<030>
<035> Program Vear Mi ke F"ellciHlll'.o
<039> Contact Name - Person USAC should contact regarding this data

Contact Telephone Number - Number of person identified in data line <030> ' 1054 23605 ext.

Contact Email Address· Email Address of person identified in data line <030> mi ke. tel ici aa i rnoevi aero .com

<140> Coverage and Performance Report Vea r 01/2014 - 0 6/ 201S

c ompleted . z i p

Coverage and Performace attachements

<141> - "'Qb,,..J- < 41>' cll1> .:.;. ,. : <b2> " ..• cb3» ~ ~- :.::~ .;-.:: . ,f' <d> ~J> .l;.J I
q j >I

Total

Road Road Certify that
Coverage and
Road Miles per Miies Performance datll
Is uploaded
Resident TotaI Resident Miies Census covered (Yes/no)

Re.sident Population Population per Block per

Population per Newly Reached Reached by Census Newly Census

State County Census Block Census Block by Service Service Block Reached Block

ed · --· --- c~ee attach
, p p t- 1 . J l l \ . : " ' 1 .

--

DPercentage of Total DPercentage of Total

Population Reached by Road M iles covered

Service by Service

06/2~/2015

Page3

<010> Study Area Code 378017
<015> StudyArea Name Nl:l Colorado Cel lular. I nc .
<020> Pr ram Year 2015
<030> Contact Name · Person USAC should contact regarding this data Mi ke PeliciHimo
<03S> Contact Telephone Number - Number of person identifled in data line <030> 9705423605 ext.
<039> Contact Email Address - Email Address of person identified in data line <030> mike . f el icissimo9via er o.com

TO BE COMPLET£D BY THE REPORTING CARRIER, IF TME REPORTING CARRIER IS FILING CERTIFICATION DATA ON ITS OWN BEHALF:

Certification of Officer or Employee as to Compliance with 47 CFR §54.1009(a)(4)

I certify that I am an officer or employee of the reporting carrier; my responsibllltles include ensuring compliance with 47 CFR §54.1009(•)(4), the Information reported on this
form and In any attachments ls accurate.

Name of Re ortin Carrier: NE Col orado Cel l u l ar . Inc .

Si nature of Authorized Officer: CERTIFIED OOLINB Date o6/ 30/201s

Printed name of Authorized Officer: Mi ke t' el1c1eaiir.o
'tion of Authorized Officer: Executive Vice Presi dent.

9 7 0~ 4 23605 ext .

Stud Area Code of Reportin Carrier: 378017 Fllln Due Date for this form: o7 /01 / 2015

Persons willfully making false statements on this form con be punished by fine or forfeiture under tht Communicotions Act of 1934, 47 U.S.C. §§ 502, S03(b), or fine or imprisonment
under Title 18 of the United States Code, 18 U.S.C. § 1001.

TO BE COMPLETED BY THE REPORTING CARRIER, IF AN AGENT IS FILING CERTIFICATION DATA ON THE CARRIER'S BEHALF:

Certification of Officer or Employee to authorize an Agent to file Compliance with 47 CFR §54.1009(a)(4) on Behalf of Reporting carrier

I certify that (Name of Agent ls authorized to submit the Information reported on behalf of the reportlng

canler. I also certify that I am an olllcer or employee of the reporong carrier; my responslbllltles Include ensuring compliance with 47 CFR §54.1009(aK4l reported to the

authorized a ent· and, to the best of knowled the re Orts and data rovlded to the authorized a ent ls accurate.

Date:

Filin Due Date for this fo rm:
Persons wilKully making f1lse statements on this form con be punished by fine o r forfeiture under the Communications Act of 1934, 47 U.S.C. ff 502, 503(b), or fine or imprisonment

under Title 18 of the United States Code, 18 U.S.C. § 1001.

TO BE COMPLET£0 BY THE AUTHORIZED AGENT:

Certification of Aaent Authorized to Rle Compliance with 47 CFR §54.1009(a)(4) on Behalf of Reporting carrier
I, n acent for the reportlng carrier, cert.ify that I am authorized to submit the certification on behalf of the reporting carrier; I have provided the data reported herein based on
data provided by the reporting carrier; and, to the best of my knowledge, the Information reported herein l.s accurate.

Date:

ent:
Fili Due Date for this form:

Persons willfully making false statements on this form con be punished by fine or forfeiture under the Communications Act of 1934, 47 U.S.C. §§ 502, 503{b), or fine or imprisonment under
Title 18 of the United S!Atts Code, 18 u .s .c . § lool .

Page4

0 6/ 29/ 2015

<010> Study Area Code 378017
<015> Study Area Name N2 Colorado Cel l ular, Inc .
<020> Program Year 2015
<030> Contact Name - Person USAC should contact regarding this data Mike Pelicieaitn0
<035> Contact Telephone Number - Number of person identified in data line <030> 97054236 05 ~.xt.
<039> Contact Email Address - Email Address of person identified in data line <030> mikt Celiciooi!!!S$yiAtro c om

<142> State

<143> County

<144> Tribal Land(s) on which ETC Serves

<145> Tribal Government Engagement Obligation

Name ofAttach~ Document (.pd/)

If your company serves Tribal lands, please select (Yes, No, Not Applicable) for
each of these boxes to confirm the status described on the attached
PDF, on line 145, demonstrates coordination with the Tribal
government pursuant to§ 54.1004 includes:

Select
(Yes, No, Not Applicable)

<146> Needs assessment and deployment planning with a focus on Tribal
community anchor institutions;

<147> Feasibility and sustainability planning;
<148> Marketing services in a culturally sensitive manner;
<149> Compliance with Rights of way processes
<150> Compliance with Land Use permitting requirements

<151> Compliance with Facilities Siting rules
<152> Compliance w ith Environmental Review processes
<153> Compliance with Cultural Preservation review processes
<154> Compliance w ith Tribal Business and Licensing requirements.

Pages

06/29/201S

<010> Study Area Code 378017
<015>
<020> Study Area Name NS Colondo Ce llular. inc.
<030>
<035> Program Year 2015
<039>
Contact Name - Person USAC should contact regarding this data 1'.ike Peliciaalmo

Contact Telephone Number - Number of person identified in data line <030> 9705423605 ext.

Contact Email Address - Email Address of person identified in data line <030> ..1ke.feliciali.-viaero.com

<200> Date Authorized to Receive Support 101/29/2013
<201> Targeted Completion Date 107/31/2016
<202> Total Mobility Fund Support Awarded 131468.98
<203> Total Mobility Fund Support Disbursed

<210> Actual Completion Date Nebraaka Sitea in beginning stage.pd!
<211> Project Status Description (attached)

<212> Please check these boxes below to confirm that the attached PDF, on line ./
<213> 211, contains a project status pursuant to §54.100S(b)(2)(v). The information ./
<214> shall be submitted as appropriate. ./
<215> Status of Network Deployment - Network Design
<216> Status of Network Deployment - Construction ./
<217> Status of Network Deployment - Deployment
Status of Network Deployment - Maintenance
Project Budget Status
Project Plan Status

<218> Certify Network will Support 3G/4G Mobile Service (Yes I No) ®0

Page6

06/29/2015

<010> Study Area Code 378017
<015> Study Area Name NB COl orado Cellul•,r, Inc.
<020> Program Year
<030> Contact Name - Person USAC should contact regarding this data 2015
<035> Contact Telephone Number - Number of person identified in data line <030> Mike FeliciHimo
<039> Contact Email Address - Email Address of person identified in data line <030> 97054 23605 ext.
mike. fe liciHi .-Viaero.com

TO BE COMPLETED BY THE REPORTING CARRIER, IF THE REPORTING CARRIER IS FILING ON ITS OWN BEHALF:

Certification of Officer as to the Accuracy of the Data Reported for Moblllty Fund Recipients

I certify that I am an officer of the reporting carrier; my responsibilities lndude ensuring the accuracy of the reporting requirements for Mobility Fund recipients; and, to the
best of my knowledge, the Information reported on this form and in any attachments Is accurate.

Name o f Reporting Carrier: NE Colora do Cell\ll ar, I nc .

Signature of Authorized Officer: CERTIFIED ONLINE Date 06/ 30/ 201 5

Printed name of Authorized Officer: ~ilte F'elici s aimo

-rtle or oosltion of Authorized Officer: EXe cucive Vi ce Presi dent

Telephone number of Authorized Officer: 97054 23605 e xt .

Study Area Code of Reporting Carrier: 378017 Filing Due Date for this form: 07/01/20 15

P~sons willfully makine false statements on thisform can be punished by fine°' forteiture under the CO<nmunlcationsAct of 1934, 47 U.S.C. §§ 502, 503(b), °'fine°' imprisonment
under Trtle 18 of the United States Code, 18 U.S.C. § 1001.

0 6/29/ 2015 Page7

<010> Study Area Code 378017
<015> Study Area Name NE COl orado Cellular, lnc.
<020> Pr ram Year
<030> Contact Name • Person USAC should contact regarding this data 201 5
<035> Contact Telephone Number · Number of person Identified in data line <030> Mike Felicissimo
<039> Contact Email Address · Email Address of person Identified in data line <030> 9705423605 ext.
mike. fel i cissim09\l'iaero .com

TO BE COM PLmD BY THE REPORTING CARRIER, IF AN AGENT IS FILING ON THE CARRIER'S BEHALF:

Certification of Officer to Authorize an Agent to File for Mobility Fund Recipients on Behalf of Reporting carrier

I eertlty that (Name of Agtntl Is authorized to 1ubmit the Information reported on behalf of the reporting carrier. I

!also certify that I am an officer of the reporting carrier; my responslbllltlts Include ensuring the accuracy of the data reporting requirements provided to the authorized

agent; and, to the best of my knowledge, the reports and data provided to the authorized agent is accurate.

Name of Authorized Aaent:

Name of RePorting Carrier.

Silmature of Authorized Officer: Date:

Printed name of Authorized Officer:

ITitle or position of Authorized Officer:

Telephone number of Authorized Officer: FillnJt Due Date for this form:

Study Area Code of ReoortinJt Carrier:

Penons willfully maklnc f1lse mtements on this form con be p<1ni$hed by fine or forfeiture under the CommunlCltions Act of 1934. 47 u.s.c. §§ 502, 503(b), or fine 0< impri$onment
under Trtle 18 of the United StltH Code, 18u.s.c. § 1001.

TO BE COMPLETED BY THE AUTHORIZED AGENT:

Certification of Agent Authorized to File for Mobility Fund Recipients on Behalf of Reporting Carrier

I,., agent for the reportinc carrier, certify that I am authorltecl to submit the reports for Mobility Fund l'e()lplents on behalf of the reportlnc carrier; I have provided the d•ta
reported herein based on data provided by the reportl,. earner; 1nd, to the best of my knowledge, the lnform1tlon reported herein is 1CQ1rate.

Name of ReportinR Carrier:

Name of Authorized Agent or Employee of Agent:

Sl.:nature of Authorized Altent or Emolovee of AJtent: Date:

Printed name of Authorized Aaent or Employee of Aaent:

ITitle or pasition of Authorized Aaent or Employee of A&ent

Teleohone number of Authorized Aaent or Emolovee of Altent:

Study Area Code of ReDortinR Carrier: FillnJt Due Date for this form:

Persons willfully making fllse statements on this form con be punished by fine or forfeiture under the Communlcotions Act of 1934, 47 U.S.C. §§ S02, 503(b), or fine or Imprisonment under Tiiie

I I18 of the United States Code, 18 u.s.c. § 1001.

Pages

06/29/201 5

Attachments

06/29/2015

<010> Study Area Code 318017
<015>
<020> Study Area Name ~'l? Colorado Cellul ar. Inc.
<030>
<035> Program Year 2015
<039>
<140> Contact Name - Person USAC should contact regarding this data Hi lte Pelici11i100

<141> Contact Telephone Number - Number of person identified in data line <030> 9705423605 e xt.

Contact Email Address - Email Address of person identified in data line <030> Oli ke. !eliciui_,,1..,ro .COOi

-· ·-Coverage and Performance Report Year 07/2014 - 06/2015

·2 ' h : ' qJ> ...~A~ - ~ ·...,."'. ......... . ..... -.; .)' '::./ ...q:lJO ·.:i:.., .:~ , ~k'·~'• "'·~t. ~r. : '.";, ~-. <ct> l I

State Countv Census 8lock Resident Resident Totll Rasldtt1t Road Miies Road Miies Total Road Clftify th1t
llB Garfiel d 0000 Population pet Population Popul1tlon perC•uus per Census Miles Coverage 1nd
Census Block Re1cloed by llock Newly covered per Perfonnacne
Newly Reached Block Reac'1ed Ctt1su.s Block data Is uploaded
by Service Service
o.o o.o 0.0 (yes/no)
0 00
Yes

Percentage of D Percentage of Total D
Total Population Road Miles covered

Reached by by Service
Service

0 6/29/2015

Mobility Fund 378018 FCCfo
~E COl or•do Cellular, Inc. Approved by 0
Phase 1 • §54.1009 Annual Reporting 201 5
Date Collection Form Mike Peliciaaimo Hou s

<010> Study Area Code JUL - 11015

<015> Study Area Name Office of the Secretary

<020> Program Year

<030> Contact Name: Person USAC should contact

with questions about this data

<035> Contact Telephone Number: 970~4 23605 en.

Number ot the person identitied In data line <030>

<039> Contact Email : mike. tellciHim<>eviaero.com
Email ot the person identit ied in data line <030>
I,
.,. '. c fj f i'f ., 2• Ell'
f '?
(cllttk box when comp/et•)

Q<040> Has the information requi red pursuant to §54.1009 been provided with a Form 481 filing IY/N) <040> @

<041> Attach a description of the documents filed with the Form 481 reporting 4MDI

<042> Cite the Study Area Code (SAC) for the Form 481 reporting <042>

<OSO> Carrier Contact Information (compl•lf 11ttod>td worl<shtet) [Z]<050>

<060> Coverage and Performance Report <060> [Z]
[Z]<070>
<070> Urban Rate Comparability Certification
0@
<080> Tribal lands Reporting (yin?) ttmsthissWdyoroocovtrtrlbollands?YnrxNo)
(IfYt•, comp~t• th• ottodltd worlrsllttt) <080> 0

<090> Pro!ect Update Information (comp~t• ott11<htd worksllttt} [Z]<090>

<100> Certifications (comp~t• ottochtd ctrt/flcotlon) [Z]<101>
<101> Reporting Carrier Certification (compkt• ottod>td OffflflCOtlon}
<102> 0
<102> Agent Certification

Notice to Individuals Required by the Paperwork Reduction Act of 1995
OMB Control Number 3060-1185 (Annual Report for Mobility Fund Phase I Support, FCC Form 690 and Record Retention Requirements)
Notice to Individuals Required by the Paperwork Reduction Act of 1995
Public reporting burden for this collection of information is estimated to average 18 hours per response. Our estima te includes the time to read
the instructions, look through existing records, gather and maintain required da ta, and actually complete and review the form or response . If you
have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal
Communications Commission, Office of Managing Director, AM D·PERM, Washington, DC 20554, Paperwork Reduction Act Project (3060·1185).
Please DO NOT SEND COMPLITTD FORMS TO THIS ADDRESS. You are not required to respond to a collect ion of information sponsored by the
Federal government, and the government may not conduct or sponsor this collection, unless it d isplays a currently valid OMB control number
and/or we fail to provide you with this notice. This collection has been assigned an OMB control number of 3060·1185.

THIS NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.

06/29/2015

Page 1